As I was holding retractors one day this week, an awful fit of hunger hit me. I looked at the OR’s clock and realized that I hadn’t eaten in about 9 hours. I also realized that this operation was going to run another 2-3 hours and I would probably miss lunch again. In order to fight off the hunger, I propose that surgeons wear a camel back under their sterile gowns. Commonly used by long distance runners and hikers, a camel back is a back pack that contains water for the purpose of keeping hydrated on the go. A tube runs from the bag, over the wearer’s shoulder, and directly into his mouth. Whenever the runner wants a sip of water, he simply tilts his head toward the flexible straw, takes a drink, and keeps moving. In a similar fashion, surgeons could benefit from these devices during long procedures.

I could use a camel back to hold a can of soup to deliver it to me whenever I start to get hungry. I’ve got three whipples scheduled next week and I’m already thinking of ways to get fed during the surgeries. If I’m going to get varicose veins and hemorrhoids from standing for so long, at least I should be able to fight off the constant hunger pains.

To make matters worse, the bovie-the devices that melts human flesh and cauterizes wounds-makes everything smell like barbecue. A few of my readers might get turned off by the reference to cannibalism, but I call a smell like I sense it.

Perhaps my greatest frustration with surgery is that so many of the residents and students want to perform operations without ever thinking of the reasons why a particular procedure works, or why certain medications are used before and after major procedures. The chief cracks on internists by saying, “They’re only concerned about mechanisms of action and susceptibility.” What he doesn’t realize is that those mechanisms are extremely important. There’s a reason why diabetic patients take ACE inhibitors and not beta blockers. Unfortunately, our attending seems to follow the same line of thought and puts every patient on Reglan and prophylactic triple antibiotic therapy, meaning that all of those whipple patients now have super infections and are at risk for Parkinson’s disease. He could prevent the former problem from ever occurring if he would just wash his hands and use sterile gloves whenever he digs into a patient’s abdomen to look at the surgical site.

As part of the never ending line of assignments that I have to fulfill, I had to go to the residents’ lecture this week. The topic was on fluid management and reviewed all of the material that I had to learn last year as a 2nd year medical student. I was surprised as how elementary the material was. I was even more surprised during the review section when so many senior residents got questions wrong about basic electrolyte balance. It was like watching retards compete in the math Olympics.

Question: what will a high glucose level due to the patient’s sodium level?
Actual surgeon answer: if a person eats a lot of sugar, he must also eat a lot of salt. Therefore, it would be elevated.

Surgeons shouldn’t strive to be only knife jockeys. Anybody can cut stuff out of a patient. Even the scrub nurses have seen enough operations to know how to remove an appendix without causing too many complications. What makes surgeons unique is the “M.D.” after their names. If nothing else, they should at least know more about fluids and electrolytes than a fresh third year medical student.

halfmdsaid,

I certainly make sure to go to the bathroom before each surgery. Unfortunately, the surgeons’ manners aren’t so great. Our OR’s lockerroom looks as if a wet dog shook off in there. It’s worse than a truck stop restroom. I wonder why surgeons have such a hard time lifting the toilet seat whenever they pee from a standing position.

REO SpeedDealersaid,

This is why it is of critical importance to find a good out of the way bathroom that most people don’t use. Even as an overloaded ultra busy intern, it was worth a few extra minutes to take a crap in solitude. As for why surgeons don’t raise the seat or take many steps to provide common courtesy to others… most of them have the humanity beaten out of them during their residency training. If you are treated like a dog for long enough, you start behaving like one. I have seen classmates and good friends go through surgical training and come out the other side as totally different people. It is like growing up in an abusive household. When you have kids, you’ll beat them too, because it is all you know about parenting. I seriously considered surgery as a career, but couldn’t see myself joining such a dysfunctional family.

I believe the answer to the high sodium question is that high glucose can cause dehydration and thus a concentrational hypernatremia. But I’m not positive, and I’ve never read anything to that effect, it’s just me reasoning it out.

Stalwart Hospitalistsaid,

Hyperglycemia causes hyponatremia. The osmotic effect of the very high glucose level pulls more water into the vascular space, reducing the sodium concentration.

A rough estimate of the effect on the serum sodium is as follows: the sodium level will drop 1.8 mEq/dL for each 100 mg/dL the glucose level is above 100 mg/dL. (For example, a glucose level of 600 would be expected to drop the sodium level 5 x 1.8, or 9 points.)

halfmdsaid,

Bingo! It’s a dilutional effect. I’m surprised that so many residents don’t know something that was taught in freshman chemistry. Also, patients presenting with unexplained hyponatremia should be screened for hypothyroidism.